scholarly journals Thyroid volumes in a national sample of iodine-sufficient swiss school children: comparison with the World Health Organization/International Council for the control of iodine deficiency disorders normative thyroid volume criteria

2000 ◽  
pp. 599-603 ◽  
Author(s):  
SY Hess ◽  
MB Zimmermann
Keyword(s):  
Iodine Deficiency ◽  
Reference Data ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
National Sample ◽  
World Health ◽  
Normative Values ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders

OBJECTIVE: The determination of goiter prevalence in children by thyroid ultrasound is an important tool for assessing iodine deficiency disorders. The current World Health Organization/International Council for the Control of Iodine Deficiency Disorders (WHO/ICCIDD) normative values, based on thyroid volume in iodine-sufficient European children, have recently been questioned, as thyroid volumes in iodine-sufficient children from the USA and Malaysia are smaller than the WHO/ICCIDD reference data. Our objective was to describe ultrasonographic thyroid volumes in a representative national sample of iodine-sufficient Swiss school children, and to compare these with the current reference data for thyroid volume. DESIGN AND METHODS: A 3-stage, probability proportionate-to-size cluster sampling method was used to obtain a representative national sample of 600 Swiss children aged 6-12 years. The following data were collected: thyroid size by ultrasound, urinary iodine concentration, weight, height, sex and age. RESULTS: The median urinary iodine concentration (range) of the children was 115 microgram/l (5-413). Application of the WHO/ICCIDD thyroid volume references to the Swiss children resulted in a prevalence of 0%, using either age/sex-specific or body surface area (BSA)/sex-specific cut-off values. Upper limits of normal (97th percentile) of thyroid volume from Swiss children calculated using BSA, sex and age were similar to those reported in iodine-sufficient children in the USA, but were 20-56% lower than the corresponding WHO/ICCIDD references. CONCLUSIONS: Swiss children had smaller thyroids than the European children on which the WHO/ICCIDD references are based, perhaps due to a residual effect of a recent past history of iodine deficiency in many European regions. However, there were sharp differences between our data and a recent set of thyroid volume data in Swiss children produced by the operator and equipment that generated the WHO/ICCIDD reference data. This suggests that interobserver and/or interequipment variability may contribute to the current disagreement on normative values for thyroid size by ultrasound in iodine-sufficient children.

scholarly journals Thyroid ultrasound compared with World Health Organization 1960 and 1994 palpation criteria for determination of goiter prevalence in regions of mild and severe iodine deficiency

2000 ◽  
pp. 727-731 ◽  
Author(s):  
M Zimmermann ◽  
A Saad ◽  
S Hess ◽  
T Torresani ◽  
N Chaouki
Keyword(s):  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Classification Systems ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Thyroid Ultrasound ◽  
Iodine Deficiency Disorders ◽  
Goiter Prevalence

OBJECTIVES: In 1994, WHO/International Council for the Control of Iodine Deficiency Disorders recommended replacing the WHO 1960 four-grade goiter classification with a simplified two-grade system. The effect of this change in criteria on the estimation of goiter prevalence in field studies is unclear. In areas of mild iodine deficiency disorders (IDD) where goiters are small, ultrasound is preferable to palpation to estimate goiter prevalence. However, in areas of moderate to severe IDD, goiter screening by palpation may be an acceptable alternative to thyroid ultrasound. To address these two issues, we compared WHO 1960 and 1994 criteria with thyroid ultrasound for determination of goiter prevalence in areas of mild and severe IDD in Morocco. DESIGN: A cross-sectional study of 400 six- to 13-year-old children from two mountain villages (Ait M'hamed and Brikcha) in rural Morocco was carried out. METHODS: Urinary iodine concentration (UI), whole blood TSH and serum thyroxine were measured. Thyroid size was graded by inspection and palpation by two examiners using both WHO 1960 and 1994 criteria. Thyroid volume was determined by ultrasound. Variation between examiners and examination methods was assessed. Sensitivity and specificity of the two classification systems compared with ultrasound were calculated. RESULTS: Median UIs in Ait M'hamed and Brikcha were 183 and 24 microg/l respectively. In Ait M'hamed, using 1960 and 1994 criteria, goiter prevalence was 21 and 26% respectively, compared with 13% by ultrasound. In Brikcha, with 1960 and 1994 criteria, goiter prevalence was 64 and 67% respectively, compared with 64% by ultrasound. Agreement between observers was better with the 1994 criteria than with the 1960 criteria in Ait M'hamed (kappa=0.53 and 0.47 respectively), while in Brikcha observer agreement was similar with the two systems (kappa=0.67). Using either the 1994 or 1960 criteria, agreement with ultrasound was only moderate in Ait M'hamed (kappa=0.41-0.44), but good in Brikcha (kappa=0.55-0.64). Overall, compared with ultrasound, sensitivity increased 3-4% using 1994 criteria, while specificity decreased 4-5%. CONCLUSIONS: The WHO 1994 criteria are simpler to use than the 1960 criteria and provide increased sensitivity with only a small reduction in specificity. Agreement between observers is better with the 1994 criteria than with the 1960 criteria, particularly in areas of mild IDD. Like the 1960 criteria, the 1994 criteria overestimate goiter prevalence in areas of mild IDD, compared with ultrasound. However, the 1994 palpation criteria provide an accurate estimate of goiter prevalence in areas of severe IDD, and may be an acceptable and affordable alternative to thyroid ultrasound in these areas.

scholarly journals Determination of Thyroid Volume by Ultrasonography among Schoolchildren in Philippines

2012 ◽  
Vol 2012 ◽  
pp. 1-6 ◽  
Author(s):  
Bu Kyung Kim ◽  
Young Sik Choi ◽  
Chul Ho Oak ◽  
Yo-Han Park ◽  
Jae Hyun Kim ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
Reference Data ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Cross Sectional ◽  
Mean Values ◽  
Logistic Issue ◽  
Reported Data

Objective. Iodine deficiency is defined by the goiter and the urinary iodine concentration. However, a lack of local thyroid volume reference data resulted in the vague definition of goiter, especially in school-aged children. The aim of this paper was to determine the thyroid volumes by ultrasonography in schoolchildren aged 6 to 12 years living in Cagayan areas in Philippine.Methods. Cross-sectional thyroid ultrasonographic data of 158 schoolchildren aged 6–12 years from Tuguegarao and Lagum in Cagayan valley, Philippine were used. Thyroid volumes were compared based on logistic issue and urban and rural area and compared with other previously reported data.Results. The mean values of thyroid volume in Tuguerago and Lagum were2.99±1.34 mL and2.42±0.92 mL. The thyroid size was significantly in association with age (P<0.00), weight (P<0.00), height (P<0.00), and BSA (P<0.00) by Pearson’s correlation. The median thyroid volumes of schoolchildren investigated in this study were generally low compared to international reference data by age group but not by BSA.Conclusions. We propose for the first time local reference ultrasound values for thyroid volumes in 6–12 aged schoolchildren that should be used for monitoring iodine deficiency disorders.

scholarly journals Assessment of iodine status among school age children and pregnant women of Belarus in 2017–2018

2018 ◽  
Vol 14 (3) ◽  
pp. 149-155
Author(s):  
Tatiana V. Mokhort ◽  
Sergei V. Petrenko ◽  
Boris Y. Leushev ◽  
Ekaterina V. Fedorenko ◽  
Natalia D. Kolomiets ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
School Age Children ◽  
Normative Values ◽  
Urinary Iodine Concentration ◽  
School Age ◽  
Iodine Sufficiency

Background. Despite the measures taken by the Government of Belarus, the problem of iodine deficiency among the population remains actual. Aims. To determine iodine sufficiency in children and pregnant women living in Belarus. Materials and methods. The study included 873 schoolchildren aged 9–12 years of both sexes, of which 650 children were in regular schools, and the remaining children in boarding schools. A separate group consisted of 700 practically healthy pregnant women (during gestation from 16 to 36 weeks). Questioning, determination of urinary iodine concentration and thyroid volume with ultrasound was carried out. Results. Urine iodine median was 191 µg/L in the 873 children in 16 regions of Belarus. Thyroid volume corresponds to the normative values in children. According to the survey, 81% of households used iodized salt, constantly – 46%. Indicator of iodine sufficiency of 700 pregnant women (median urinary iodine concentration was 121 µg /l) is a non-optimal for this population group. Conclusions. Currently adequate iodine supplementation in school age children has been achieved. The prevalence of thyroid gland diseases caused by iodine deficiency in children decreased significantly. In pregnant women iodine supply is still insufficient.

scholarly journals Local versus WHO/International Council for Control of Iodine Deficiency Disorders-recommended thyroid volume reference in the assessment of iodine deficiency disorders

1999 ◽  
pp. 491-497 ◽  
Author(s):  
LC Foo ◽  
A Zulfiqar ◽  
M Nafikudin ◽  
MT Fadzil ◽  
AS Asmah
Keyword(s):  
Iodine Deficiency ◽  
Body Surface ◽  
Reference Data ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Deficiency Disorders ◽  
Surface Areas ◽  
Local Reference ◽  
Goitre Prevalence ◽  
Deficient Area

OBJECTIVE: Iodine deficiency endemia is defined by the goitre prevalence and the median urinary iodine concentration in a population. Lack of local thyroid volume reference data may bring many health workers to use the European-based WHO/International Council for Control of Iodine Deficiency Disorders (ICCIDD)-recommended reference for the assessment of goitre prevalence in children in different developing countries. The present study was conducted in non-iodine-deficient areas in Malaysia to obtain local children's normative thyroid volume reference data, and to compare their usefulness with those of the WHO/ICCIDD-recommended reference for the assessment of iodine-deficiency disorders (IDD) in Malaysia. DESIGN AND METHODS: Cross-sectional thyroid ultrasonographic data of 7410 school children (4004 boys, 3406 girls), aged 7-10 years, from non-iodine-deficient areas (urban and rural) in Peninsular Malaysia were collected. Age/sex- and body surface area/sex-specific upper limits (97th percentile) of normal thyroid volume were derived. Thyroid ultrasonographic data of similar-age children from schools located in a mildly iodine-deficient area, a severely iodine-deficient area, and a non-iodine-deficient area were also collected; spot urines were obtained from these children for iodine determination. RESULTS: The goitre prevalences obtained using the local reference were consistent with the median urinary iodine concentrations in indicating the severity of IDD in the areas studied. In contrast, the results obtained using the WHO/ICCIDD-recommended reference showed lack of congruency with the median urinary iodine concentrations, and grossly underestimated the problem. The local sex-specific reference values at different ages and body surface areas are not a constant proportion of the WHO/ICCIDD-recommended reference. A further limitation of the WHO/ICCIDD-recommended reference is the lack of normative values for children with small body surface areas (<0.8m2) commonly found in the developing countries. CONCLUSION: The observations favour the use of a local reference in the screening of children for thyroid enlargement.

scholarly journals A programme of iodine supplementation using only iodised household salt is efficient--the case of Poland

2001 ◽  
pp. 331-337 ◽  
Author(s):  
Z Szybinski ◽  
F Delange ◽  
A Lewinski ◽  
J Podoba ◽  
M Rybakowa ◽  
...  
Keyword(s):  
World War Ii ◽  
Iodine Deficiency ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
Urinary Iodine Concentration ◽  
Mean Values ◽  
Iodine Prophylaxis ◽  
Epidemiological Surveys ◽  
Study Results

BACKGROUND: Iodine prophylaxis in Poland started in 1935 and has been interrupted twice: by World War II and in 1980 for economic reasons. Epidemiological surveys carried out after the Chernobyl accident in 1989 as well as in 1992/1993 and in 1994 as a 'ThyroMobil' study, revealed increased prevalence of goitre in children and adults. Ninety per cent of Poland was classified as an area of moderate iodine deficiency, and 10%, in the seaside area, as mild iodine deficiency territory. Iodine prophylaxis based on iodisation of household salt was introduced again in 1986 as a voluntary model and in 1997 as a mandatory model with 30+/-10 mg KI/kg salt. OBJECTIVE: The evaluation of the obligatory model of iodine prophylaxis in schoolchildren from the same schools in 1994 and 1999. METHODS: Thyroid volume was determined by ultrasonography. Ioduria in casual morning urine samples was measured using Sandell-Kolthoff's method, within the framework of the ThyroMobil study. RESULTS: Goitre prevalence decreased from 38.4 to 7% and urinary iodine concentration increased from 60.4 to 96.2 microg/l mean values between 1994 and 1999. In four schools the prevalence of goitre diminished below 5%. In 1999, 70% of children excreted over 60 microg I/l, and 36% over 100 microg I/l, whereas in 1994 the values were 44 and 13% respectively. CONCLUSION: The present findings indicate that iodine prophylaxis based only on iodised household salt is highly effective.

scholarly journals Lack of dietary sources of iodine and the prevalence of iodine deficiency in rural women from Sidama zone, southern Ethiopia

2013 ◽  
Vol 13 (60) ◽  
pp. 8401-8414
Author(s):  
T Gebreegziabher ◽  
◽  
N Teyike ◽  
A Mulugeta ◽  
Y Abebe ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Iodine Deficiency ◽  
Rural Women ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Iodized Salt ◽  
Southern Ethiopia ◽  
Urinary Iodine Concentration ◽  
Iodine Deficiency Disorders ◽  
Dairy Consumption

Iodine deficiency has been reported to affect a large number of people in Ethiopia. Although significant progress against iodine deficiency disorders (IDD) has been reported worldwide, millions of people remain with insufficient iodine intake. Multiple factors may contribute to iodine deficiency. Hence, the objective of this study was to investigate iodine deficiency and dietary intake of iodine. A cross-sectional survey design was used to assess urinary iodine concentration (UIC), goiter and dietary intake of iodine in a sample of 202 non-pregnant women living in three rural communities of Sidama Zone, southern Ethiopia. Urinary iodine concentration was analyzed using the Sandell-Kolthoff reaction, goiter was assessed using palpation and dietary source of iodine was assessed using a food frequency questionnaire. Data were analyzed using selected descriptive and analytical statistical measures with SAS software. Mean (SD) age, mid upper arm circumference (MUAC) and body mass index [BMI -Wt(kg)/(Ht(m))2] were 30.8(7.9) y, 24.8(2.5) cm and 20 (2.2) respectively. Median UIC was 37.2 µg/L. Participants with UIC <20 µg/L, classified as severely iodine deficient were 22.8%; 46.5% had UIC between 20 to <50 µg/L, classified as moderately iodine deficient, and 27.2 % had UIC in the mild deficiency range of 50 to <100 µg/L. Only 3.5% of the women had UIC ≥ 100 μg/L. The total goiter rate was 15.9%, which was 1.5% visible and 14.4% palpable goiter. A majority of the participants consumed Enset (E. ventricosum), corn and kale frequently and meat was consumed rarely. None of the participants reported ever consuming iodized salt or ever having heard about use of iodized salt. Adjacent communities (Alamura, Tullo and Finchawa) showed significant differences in UIC, goiter rate and frequency of fish and dairy consumption. The findings of the present study revealed that iodine status of the population is a significant public health problem. Hence, there is a need to supply iodized salt in order to achieve the goal of elimination of iodine deficiency disorders in the community.

scholarly journals Iodine Deficiency and Goiter Prevalence of the Adult Population in Erzurum

2005 ◽  
Vol 48 (1) ◽  
pp. 39-42 ◽  
Author(s):  
Ersin Akarsu ◽  
Güngör Akçay ◽  
Ilyas Çapoğlu ◽  
Necdet Ünüvar
Keyword(s):  
Iodine Deficiency ◽  
Adult Population ◽  
National Level ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Well Being ◽  
Iodine Concentration ◽  
Etiologic Factor ◽  
Urinary Iodine Concentration ◽  
Goiter Prevalence

It is believed that total goiter prevalence in Turkey is as high as 30.5%. The iodine deficiency is the distinct etiologic factor in the development of goiter. The aim of this study was to determine goiter prevalence and iodine deficiency in adults living in Erzurum (1659 m above sea level) for at least 10 year. The study involved 340 people (192 females, 148 males). The median age was 38.5 year (ranging from 20 to 76 years). Ultrasound-measured thyroid volume (TV) for men (TV > 25 ml) and for women (TV > 18 ml) was considered goiter indicator. By this evaluation, goiter was diagnosed in 94 (27.6 %) cases, whereas the goiter prevalence, based on the palpation method, was 5.6%. Urinary iodine concentration (UIC) was measured by ammonium persulfate method. UIC in subjects with goiter was significantly lower than that of the others (median values 5.0 vs 7.8 μg/dl, p < 0.0001). While the value of UIC ≥ 10 μg/dl (no. 121, 36.6%) was accepted normal, the extent of iodine deficiency in other subjects was classified as severe (UIC < 2.0 μg/dl, no.53, 15.6%), moderate (UIC = 2.0–4.9 μg/dl, no.75, 22%) and mild (UIC = 5.0–9.9 μg/dl, no.91, 26.8%). TV values were found to be significantly different among the four groups (p < 0.05). TV values were significantly correlated with body surface area and UIC (r = 0.15 and r = -0.16, respectively, p < 0.005). Also, the prevalence of thyroid nodules was estimated as 2.1% by palpation and 18% by ultrasonography. We conclude that goiter originating from iodine deficiency has been an important health problem in Erzurum. Besides taking measures at national level, local factors and risks which interfere with the nationwide efforts should also be dealt with for the eradication of the iodine deficiency problem. In the region, periodical evaluation of iodine level and iodine related disorders will guide the measures to be taken for the well being of people’s general health.

scholarly journals Prevalence of urinary iodine concentration among school children: in Dessie City, Ethiopia

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Birtukan Shiferaw Ayalew ◽  
Seid Legesse Hassen ◽  
Tefera Alemu Marefiyaw ◽  
Mohammed Seid Yesuf ◽  
Daniel Dagne Abebe ◽  
...  
Keyword(s):  
Iodine Deficiency ◽  
School Children ◽  
Urinary Iodine ◽  
Sampling Technique ◽  
Iodine Concentration ◽  
Laboratory Method ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Cross Sectional ◽  
Study Participants

Abstract Background Urinary iodine is recommended by the world health organization as the main indicator to assess iodine status in a population. Despite this recommendation little is known about urinary iodine concentration in the study area. Therefore, this study aimed to determine the level of urinary iodine concentration among school-aged children. Methods An institution-based cross-sectional study design was used to assess the level of urinary iodine from April to June 2019 and a systematic random sampling technique was applied to select study participants. Socio-demographic characteristics were assessed using a pretested structured questionnaire and the laboratory method by Sandell–Kolthoff reaction method was used. Data were cleaned, coded, and entered into Epi data version 3.1 and then exported to SPSS version 21 software for analysis. Result A total of 634 study participants were enrolled in the study with a median age of 12 years (±SD = 2.0). The majority of the children were females (55.4%) and more than half of respondents report the use of iodized salt always. Median urinary iodine concentration was 158.5 μg/L (±SD = 104.1) with minimum and maximum values of 5.1 μg/L and 528.8 μg/L, respectively. The overall iodine deficiency in this study was 18.6% and severe deficiency constituted 7.4%. Conclusions The iodine deficiency of the school children aged 6 to 14 in the present study was 18.6% indicating high prevalence. A high proportion of iodine deficiency was observed among females and it increases as age increases. This indicates the need for an additional strategy to control iodine deficiency.

scholarly journals Iodine nutrition among the adult population of the Faroe Islands – a population-based study

2021 ◽  
pp. 1-22
Author(s):  
Herborg Líggjasardóttir Johannesen ◽  
Gunnar Sjúrðarson Knudsen ◽  
Stig Andersen ◽  
Pál Weihe ◽  
Anna Sofía Veyhe
Keyword(s):  
Iodine Deficiency ◽  
Adult Population ◽  
Urinary Iodine ◽  
Iodine Concentration ◽  
Population Based ◽  
Iodine Intake ◽  
World Health ◽  
Urinary Iodine Concentration ◽  
Faroe Islands ◽  
Iodine Nutrition

Abstract The World Health Organization recommends monitoring iodine status in all populations with median urinary iodine concentration below 100 µg/L suggesting iodine deficiency. There are no data on the iodine intake among the population of the Faroe Islands. This study aimed to provide data on iodine nutrition in a representative sample of the general adult population from the Faroe Islands. We conducted a population-based cross-sectional survey in 2011-2012 and measured iodine in urine from 491 participants (294/197 men/women) using the ceri/arsen method after alkaline ashing. Participants include around 100 subjects in each of four adult decades and included participants from both the capital city and villages. The median urinary iodine concentration was low within the recommended range 101 µg/L (range 21-1870 µg/L). No samples were in the range suggesting severe iodine deficiency, but half of the samples were in the range of just adequate or mildly insufficient iodine intake with urinary iodine concentration markedly lower in women than in men (86 versus 115 µg/L; P<0·001). Intake of fish and whale meals affected the urinary iodine concentrations. In conclusion, nearly half of the population had an iodine excretion in the range of borderline or mild iodine deficiency. The lowest iodine nutrition level among Faroese women is a concern as it may extend to pregnancy with increased demands on iodine nutrition. In addition, we found large variations and the intermittently excessive iodine intakes warrants follow-up on thyroid function in the population of the Faroe Islands.

scholarly journals A survey of iodine intake and thyroid volume in Dutch schoolchildren: reference values in an iodine-sufficient area and the effect of puberty

2001 ◽  
pp. 595-603 ◽  
Author(s):  
WM Wiersinga ◽  
J Podoba ◽  
M Srbecky ◽  
M van Vessem ◽  
HC van Beeren ◽  
...  
Keyword(s):  
The Netherlands ◽  
Iodine Deficiency ◽  
Reference Values ◽  
Dietary Habits ◽  
Urinary Iodine ◽  
Thyroid Volume ◽  
Iodine Concentration ◽  
Iodine Intake ◽  
Height Velocity ◽  
Urinary Iodine Concentration

BACKGROUND: Iodine deficiency and endemic goiter have been reported in the past in The Netherlands, especially in the southeast. OBJECTIVE: To evaluate iodine intake and thyroid size in Dutch schoolchildren, contrasting those living in a formerly iodine-deficient region in the east (Doetinchem) with those living in an iodine-sufficient region in the west (Amsterdam area). DESIGN: Cross-sectional survey of 937 Dutch schoolchildren aged 6--18 years, of whom 390 lived in the eastern and 547 in the western part of the country. METHODS: Thyroid size was assessed by inspection and palpation as well as by ultrasound. Iodine intake was evaluated by questionnaires on dietary habits and by measurement of urinary iodine concentration. RESULTS: Eastern and western regions were similar with respect to median urinary iodine concentration (15.7 and 15.3 microg/dl, NS, Mann-Whitney U test), goiter prevalence by inspection and palpation (0.8 and 2.6%, P=0.08, chi-squared test), and thyroid volumes. The P97.5 values of thyroid volumes per age and body surface area group were all lower than the corresponding sex-specific normative WHO reference values. Iodized salt was not used by 45.7% of households. Daily bread consumption was five slices by boys and four slices by girls. Weekly milk consumption was 3 liters by boys and 2 liters by girls. Seafish was consumed once monthly. From these figures we calculated a mean daily iodine intake of 171 microg in boys and 143 microg in girls, in good agreement with the measured median urinary concentration of 16.7 microg/dl in boys and 14.5 microg/dl in girls. The sex difference in iodine excretion is fully accounted for by an extra daily consumption of one slice of bread (20 microg I) and one-seventh of a liter of milk (8.3 microg I) by boys. Thyroid volume increases with age, but a steep increase by 41% was observed in girls between 11 and 12 years, and by 55% in boys between 13 and 14 years, coinciding with peak height velocity. Girls have a larger thyroid volume at the ages of 12 and 13 years, but thyroid volume is larger in boys as of the age of 14 years. CONCLUSIONS: (1) Iodine deficiency disorders no longer exist in The Netherlands. (2) Bread consumption remains the main source of dietary iodine in The Netherlands; the contribution of iodized table salt and seafish is limited. (3) The earlier onset of puberty in girls renders their thyroid volume larger than in boys at the age of 12--13 years, but boys have a larger thyroid volume as of the age of 14 years.

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